From the Guidelines
Interstitial cystitis (IC) treatment should prioritize a multimodal approach, including lifestyle modifications, oral medications, and behavioral/non-pharmacologic treatments, to maximize symptom control and patient quality of life, as suggested by the most recent guidelines 1.
Overview of Interstitial Cystitis
Interstitial cystitis (IC), also known as bladder pain syndrome, is a chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The exact cause remains unclear, but it is believed to result from defects in the protective lining of the bladder, allowing irritating substances in urine to damage the bladder wall and trigger inflammation and pain signals.
First-Line Treatments
First-line treatments include:
- Lifestyle modifications, such as avoiding trigger foods and beverages (coffee, alcohol, spicy foods, citrus) 1
- Stress management
- Bladder training techniques
- Oral medications, such as amitriptyline (10-75 mg at bedtime), pentosan polysulfate sodium (Elmiron, 100 mg three times daily), hydroxyzine (25-75 mg daily), or cimetidine (400 mg twice daily)
Behavioral/Non-pharmacologic Treatments
Behavioral/non-pharmacologic treatments, as recommended by the guidelines 1, include:
- Educating patients about normal bladder function and the benefits versus risks/burdens of available treatment alternatives
- Trials of multiple therapeutic options, including combination therapy, to achieve acceptable symptom control
- Avoiding specific behaviors that worsen symptoms, such as certain types of exercise, sexual intercourse, wearing tight-fitting clothing, and constipation 1
Additional Treatment Options
Additional treatment options, as suggested by the guidelines 1, include:
- Bladder instillations, such as DMSO (dimethyl sulfoxide) or a cocktail containing lidocaine, sodium bicarbonate, and heparin
- Physical therapy, focusing on pelvic floor relaxation
- More invasive options, such as cystoscopy with hydrodistention, Botox injections into the bladder wall, or sacral neuromodulation, for refractory cases.
From the Research
Definition and Symptoms of Interstitial Cystitis
- Interstitial cystitis (IC) is a condition characterized by symptoms of urinary frequency and urgency, dysuria, and chronic pelvic pain 2
- The symptoms of IC can be debilitating, with pelvic pain being the most difficult to control 2
- IC is also known as interstitial cystitis/bladder pain syndrome (IC/BPS) 3
Pathophysiology of IC
- The pathophysiology of IC pain is poorly understood, but is thought to be a complex entity including nociceptive, visceral, and neuropathic components 2
- The etiology of IC is unknown, but may involve microbiologic, immunologic, mucosal, neurogenic, and other yet undefined agents 4
Treatment Options for IC
- There are currently no universally effective therapies available for IC 2
- Oral treatments, such as nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, gabapentin, and pentosan polysulfate, have shown varying degrees of efficacy 2, 3, 5
- Intravesical and surgical options are also available for the treatment of IC 2, 3
- Pentosan polysulfate sodium is the only US FDA-approved oral treatment for the relief of bladder pain or discomfort associated with IC 5, 6
Pharmacologic Management of IC
- Pharmacotherapies used to treat IC/BPS include oral and intravesical agents 3
- Oral therapies include amitriptyline, hydroxyzine, cyclosporine A, and pentosan polysulfate sodium (PPS) 3
- Certolizumab pegol is a pharmacologic therapy that is currently in clinical development for the treatment of IC/BPS symptoms 3
Side Effects and Concerns
- PPS has been associated with a possible correlation with maculopathy, although this correlation is still unclear 6
- Side effects of PPS include mild haemodilution, nausea, and loss of hair 6
- An ophthalmologic examination is recommended before and during treatment with PPS due to the possible correlation with maculopathy 6